Lead Healthcare Operations Analyst

Innova Solutions•Philadelphia, PA

About The Position

Innova Solutions is hiring a Lead Healthcare Operations Analyst for a six-month contract in Philadelphia, Pennsylvania. The role monitors customer service, claims, enrollment, and supporting functions to find gaps, inconsistencies, emerging trends, and areas needing adjustment. It uses call listening and targeted transcript, claims, and enrollment reviews to identify misinformation, process breakdowns, training needs, and service risks. The analyst establishes intake, triage, ownership, escalation, and closure processes; resolves routine questions; and elevates issues requiring leadership attention. The role supports initial training and role-based readiness so affected teams understand the product, its impact on their work, and how to explain it accurately. It implements monitoring and quality controls, verifies corrective actions, and checks that changes work as intended. Working with the Project Manager, the analyst maintains an integrated issue and action tracker and provides concise updates on risks, trends, decisions, progress, and items requiring intervention. The position also connects issues across functions, reinforces effective practices, and recommends sustainable improvements to processes, training, communications, or controls. Expected outputs include a documented question intake, triage, escalation, and resolution process; an issue and action tracker with owners, priorities, status, and due dates; and regular operational-review findings and concise executive-level updates.

Requirements

At least 7 years of experience in self-funded medical insurance operations, implementation readiness, quality assurance, issue management, or a related role in a complex service environment.
Strong knowledge of customer service operations and the interdependencies among service, claims, enrollment, training, and implementation teams.
Experience identifying operational risk through call monitoring, transcript analysis, data review, claims review, or similar quality activities.
Strong judgment, organization, and follow-through.
Ability to translate complex issues into clear guidance and executive-level reporting.
Must be able to be engaged on a W-2 basis; 1099 contractors and Corp-to-Corp arrangements are not considered.

Nice To Haves

Experience in health plan administration, benefits administration, claims operations, or a similarly regulated environment.

Responsibilities

Monitor customer service, claims, enrollment, and supporting functions to identify gaps, inconsistencies, emerging trends, and areas requiring adjustment.
Conduct call listening and targeted transcript, claims, and enrollment reviews to identify misinformation, process breakdowns, training needs, and service risks.
Establish practical intake, triage, ownership, escalation, and closure processes.
Resolve routine questions and elevate issues requiring leadership attention.
Support initial training and role-based readiness activities so impacted teams understand the product, its effects on their work, and how to explain it accurately.
Implement monitoring and quality controls, verify corrective actions, and confirm changes are working as intended.
Partner with the Project Manager to maintain an integrated issue and action tracker and provide updates on risks, trends, decisions, progress, and items requiring intervention.
Connect issues across functions, reinforce effective practices, and recommend sustainable process, training, communication, or control improvements.
Document operational review findings and provide concise executive-level status updates.